Evaluation of the International "Quit and Win" Contest 1998 in Isfahan, Iran
A. Pourshams MD, N. Mohammadifard, S. Asgary PhD, I. Golshadi, N. Sarraf-zadegan MD
Isfahan Cardiovascular Research Center, Isfahan, Iran.
Background and Objective-The " Quit and Win"
contest is an international contest in which people are
invited to quit smoking. This annual contest is also held
in Iran and many participants who quit smoking win
prizes. This study was conducted to measure the one-year
post-contest abstinence rate among participants of the
international "Quit and Win" contest, 1998,
among Iranian adults residing in Isfahan province.
Methods-This cross-sectional study was
performed according to internationally agreed rules.
Approximately, 7051 current smokers aged at least 18
years, residing in Isfahan province participated in this
campaign along with over 200,000 participants from 48
countries worldwide. After 1 year (May 1999) a follow-up
questionnaire survey was conducted on 1,100 randomly
selected participants.
Results-Considering the returned
replies after the one-year follow-up by assessing the
participant’s serum cotinine levels, the one-year
quit rate was calculated to be 27.8%.
Conclusion-Although these findings should
be interpreted with caution, we conclude that the
international "Quit and Win" contest may be
considered as a convenient method with a high success
rate in producing abstinence from smoking.
Keywords · Quit and Win · smoking cessation · follow-up study · contest
Introduction
Cigarette smoking continues to be a major public health problem in Iran. According to a survey conducted in Isfahan, (central Iran) the prevalence of smoking in people over 18 years of age was found to be about 11% (20% men and 1.3% women).1 Previous surveys indicate that a significant number of individuals wish to stop smoking, but are unable to do so.2 Thus, the use of self-help programs and various contests, which provide additional incentives to quit smoking, may be of value in this effort. In comparison, the smoking cessation classes require a lot of time and are more costly. 3 The Quit and Win contest lies midway between the smoking cessation classes and self-help programs in regard to total cost, cost-effectiveness and quit-rate percentage.3 It required the same time commitment from the participants as the self-help program. The purpose of the present study was to assess the effectiveness of the international "Quit and Win" contest (a community-wide smoking cessation contest) in helping individuals to quit smoking and maintain abstinence.
Materials
Contest procedures:
The "Quit and Win" contest, which was performed in Isfahan in May 1998, as part of a joint coordination arranged by the National Public Health Institute of Finland that included over 200,000 participants from 48 countries worldwide. Our study conformed strictly to the international cooperation protocol including the same campaign time, common rules and standard follow-up procedures. The criteria for participation were as follows: Age of at least 18 years, a current smoker, smoking history of at least one year before the contest, and one witness was required to certify that the participant conformed to the rules. To promote the program and recruit for the contest, the population was informed via mass media announcements, letters to parents distributed through schools and posters displayed in shops, libraries, cinemas, main pharmacies, book shops, health centers, transport terminals and other public meeting places. To enter, participants were required to complete an entry form containing the contest procedures, demographic variables, smoking history and current smoking habits. Each participant either posted the entry form or handed it to the anti-smoking unit of Isfahan Cardiovascular Research Center.
Following the recruitment in May 1998, participants entered a one-month quitting period followed by a one-week maintenance period. The urine nicotine level was then assessed to check for abstinence. Prizes were given to randomly selected winners in June 1998.
One-year follow-up:
One year after the start of the contest (May 1999), a random sample (n=1100) of all participants (n=7051) was selected. A follow-up questionnaire about use of cigarettes within a year after the contest was designed and sent to these participants who in turn filled up the form and mailed it back. Eighty follow-up participants, who had reported as having completely quitted during the year after the contest, were randomly selected and their serum cotinine was measured by the High Performance Liquid Chromatography (HPLC).4 Cases with serum cotinine levels less than 8 µg/L were considered as non-smokers and those who had more than 8 µg/L were considered as smokers.
Results
Participants of the contest:
Seven-thousand and fifty one individuals entered the contest, among which 6,924 (98%) cases were males, 127 (2%) were females and 6204 (88%) of cases were married. The mean age of the sample was 39.4±11.7 years and the average years of education equalled 7.8±4.5 years. Among the smokers, the mean years of smoking was 16±10.5 and the average number of cigarettes used per day equalled 16.2±10.
One-year quit-rate:
Out of the 1100 randomly selected participants for follow-up, the responses of only 597 were received. Four hundred and thirty eight participants had reported as having quitted completely during the year after the contest.
These self-reports indicate an overall contest quit-rate of 39.8% (CI95%=37%-42.5%); non-respondents (503 members) were counted as smokers. About 30% (n=24) of the 80 serum samples of the follow-up participants who had reported as having quitted completely during the year after the contest, were found to have serum cotinine level of more than 8 µg/L which indicated smoking status. Using the 70% validated quit-rate to adjust for the earlier self-reported quit-rate, the adjusted quit-rate at one-year post-contest was estimated to be 27.8% (CI95%=25%-30.5%).
Discussion
Results obtained from this survey should be interpreted with caution. In any given community, there are multiple demographic groups with different preferences for health services. Different smoking cessation programs may attract different types of people, and their preferences for cessation programs may shift over time. 3 In this contest the smoking status of the participants was not evaluated by laboratory methods, which means that many participants may have been non-smokers from the beginning. The high ambition to receive a prize (e.g, economical problems) increases the possibility for the entrance of non-smokers in the contest which leads to the high quit rate seen in places where more non-smokers participated in the contest.
On the other hand, those chosen for the follow-up who had not taken part in the reply session were considered as smokers and the calculation of quit-rates is named "cautious estimate of quit-rate".5 The cautious one-year quit-rate of smoking cessation in the 1994 national "Quit and Win" campaign which was held in Finland (North Karelia) and Spain were 18.6% and 14.5% respectively.6 The cautious one-year quit-rate of smoking cessation in our study was 39.8% which is 2.7 times more than Spain and 2.1 time more than Finland. Our one-year quit-rate according to the followed-up participants’ replies and the assessment of serum cotinine level was 27.8% which is still more than the cautious rate of the mentioned countries. The reasons for this high quit-rate could be: a) ambition was high for participation because of the lack of other quitting facilities b) our lower economical status (compared to European countries) and that non-smokers may have participated more eagerly.
We conclude that besides assisting chronic smokers in quitting, smoking cessation contests, are effective in helping smokers quit and continue abstinence at least within the first post contest year.
References